Wednesday, April 8, 2009

well it had to happen, it was inevitable

Hello everyone
Well I just looked out at my little birdie metropolis the other day, and there were chipmunks and squirrels and chickadees and even a few finches feeding. But there in the middle of it all was a rat.
I did not notice him at first, (odd how I just denoted him a male without checking first) because he was just sitting chomping on the bird feed, same as all the other critters, it was the tail.
That tail gave him away.  There was nothing fluffy, or stripped or cute about his tail.
It was long, and black and.....  you know... rat like.
I thought.."oh great" "now what"....
Then I thought about it, here I am thrilled to have all these "creatures" eating at my birdfeeders, and he is doing the same, why do I HATE HIM?  I think he is even in the same creature family as the chipmunks and the squirrels....rodents.  I have not heard about a case of the Bbeubonic plague recently. Most diseases of humans seem to be contracted from being sneezed on, or touching the counters at Walmart.  So what the heck, perhaps I will let him stay.

On the topic of rats, I thought I might explain some of the details I have learned about insurance companies.  We have lived in the US for 12 years and have only just now really learned how insurance companies work. 
 When you go out and compare insurance companies I have never really known what parts to compare and what is important to me. After all, most people have insurance for just the situation I am in, yet never think they will need it.

Financially this would be considered the medical disaster.

When Ken left the university, it was the first time since we have lived here that we have had to get totally private insurance. First we had it through NBMC, then through the hospital, and then through the university.
When we applied, Ken and Josh had not been to a doctor in years, so they were approved. 
I had seen a doctor about vaginal bleeding and my case was further reviewed and I was also on a medication and I was refused insurance, I went a month without insurance.
Fortunately in Oregon, if you have been refused by an insurance company you can be covered by a plan called oregon insurance pool, it is with Regence Blue cross and I am sure there must be some government subsidy. There is no dental available and the plan I have costs me 347 a month.
My yearly deductible is 1500. Now this is where it gets complex so read carefully.
I know that for some that read this, they will already know this, but I would not be surprised if many do not. After all we have been intwined in the health care system for 12 years and only now understand this.
What this means is that each doctors visit is billed to insurance, they refuse it, I pay it and they credit me for it.
OK so I go through the first 1500 in no time, in this situation.
Then the insurance starts to pay.....
Then when  I see a doctor, who is a preferred provider they pay 70% of the visit, I pay the rest.
(I should add here that the insurance company takes the doctors bill for the service and decides what THEY determine as being allowable and lower the bill to begin with), if I see a doctor who is NOT a preferred provider (my gyne/oncologist surgeon was not) then I pay 50% of their bill.

I should add here that what ever I pay out of pocket I am credited for by the insurance company.
Now with every insurance plan you have an amount that is the total amount (per year) that you will have to pay out of pocket, and for me and this plan it was 6 thousand.
So for me, the total amount I will pay this year (with exceptions I will describe below) will be the initial 1500 deductible, plus the 6000 dollar annual out of pocket expenses
Plus I will have to pay for the first 1000 in medication costs (this is only the meds that I take at home, the rest are covered under the cancer centre bill.)
OR if any of my treatments or tests are not approved by the insurance company.
This is kind of significant because PET scans are kind of new to this stage of endometrial cancer, and if it is not something they allow for a given diagnosis I will also have to pay for it and it will not be credited to my out of pocket amounts.
(the PET scan costs 3900 dollars)
So you can see where it is good to have an "event" like mine that starts early in the year and does not stretch over into the next year. (if it did, I would have to go up to the 7500 dollars again)
My surgery/hospital stay was 30 thousand, each chemo treatment is about 7 thousand and I have no idea what radiation is going to cost.
The other thing about the insurance is that they have a 2 million dollar life time limit.
I feel fortunate to be a doctor and in the situation where the 8500, possible 11,500 will not ruin us, but I can see where it could for some, not to mention... the likely 150 thousand that my treatment will likely ultimately cost to an uninsured person. There are over 50 million uninsured people in this country, many of which might not go to doctor for perimenopausal bleeding.

I hope this description is of use to some. I am doing MUCH better today, both physically and mentally.  Physically I feel pretty much back to normal with the exception of this pelvic pain that I have had since the surgery.
I contacted my surgeon who suggested it might be a hematoma and to do an ultrasound.
We did that yesterday but because of gas they could not see anything, so they did a pelvic ct scan which showed nodularity around the vaginal cuff.
Anatomically the uterus lies in between the bladder and the bowel and the cervix is the end part of the uterus and it extends down into the vagina.
When the uterus is removed the vagina has to be sewn up at the top (closed) and this would be the vaginal cuff. The nodularity around the vaginal cuff seems to also involve the bladder and the bowel, which would explain my symptoms. The radiologist was concerned about this being cancer, but we explained that I had just had a PET scan(which should rule cancer out), so the most likely cause of this nodularity is scar tissue from the surgery.
So I feel MUCH better knowing what the pain is caused by.
The bladder is the triangle shaped thing toward the left, the uterus the the one with the numbers
6 and 7 and the bowel lies behind that.
The vagina is that thin line that goes up toward the uterus
THought this might help to get your bearings.

love and peace to all
Janet Bates

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